From the University of Pikeville Kentucky College of Osteopathic Medicine (Dr Buser) and the Department of Education at the American Osteopathic Association (AOA) in Chicago, Illinois (Mr Swartwout, Ms Biszewski, and Ms Lischka). Dr Buser is the immediate past president of the AOA.

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In 2014, the American Osteopathic Association (AOA), the American Association of Colleges of Osteopathic Medicine, and the Accreditation Council for Graduate Medical Education (ACGME) agreed to establish a new, single accreditation system for graduate medical education in the United States. The 5-year transition period, from July 1, 2015, through June 30, 2020, gives AOA training programs time to apply for and receive ACGME accreditation before the AOA ceases its postdoctoral accreditation functions. This article discusses policies to protect osteopathic residents during training, addresses program size, reviews progress at the midpoint of the 5-year transition, and looks at next steps in the establishment of the single accreditation system.

In 2014, the American Osteopathic Association (AOA), the American Association of Colleges of Osteopathic Medicine (AACOM), and the Accreditation Council for Graduate Medical Education (ACGME) reached a historic agreement to establish a new, single accreditation system for graduate medical education (GME) in the United States. The transition period to establish the new system began July 1, 2015, and ends June 30, 2020, which gives AOA training programs a 5-year window to apply for and receive ACGME accreditation before the AOA ceases its postdoctoral accreditation functions.

Previous articles on this topic have reported on the framework and benefits of the new accreditation system1 and on the organizational and policy adjustments made to prepare for the new system.2 This article discusses policies to protect osteopathic residents during training, addresses program size, reviews progress at the midpoint of the 5-year transition, and looks at next steps in the establishment of the single accreditation system.

Protecting Osteopathic Residents

Placement rates of osteopathic graduates into GME programs have been high. According to AACOM, 99.6% of 2016 osteopathic graduates seeking GME positions were successfully placed through the AOA Match (administered by the National Matching Services), National Residency Matching Program (NRMP), Supplemental Offer and Acceptance Program, military match, Urology match, San Francisco match, or scrambling into a position after matches. The 2017 placement rate was likewise high, with 99.3% of osteopathic graduates achieving GME placement.3 The placement rate for osteopathic medical students in the NRMP alone has continued to increase and reached a high of 81.7% in 2017.4 Based on these placement rates, we expect osteopathic medical students to continue to remain competitive in matching into residency training programs.

Restricted AOA Accreditation

Under the terms of the single accreditation system agreement, the AOA will cease its GME accreditation activities on July 1, 2020. However, throughout the transition, the AOA, AACOM, and ACGME have committed to protecting osteopathic residents, including trainees in AOA programs that do not achieve ACGME accreditation. To address this issue, the 3 organizations agreed in March 2017 that the AOA would retain restricted accreditation authority over those programs that do not achieve ACGME accreditation in order for the trainees to complete accredited training. Once those remaining trainees have completed their training, the AOA will cease its GME accreditation activities.5

Constraining Recruitment

To minimize the number of trainees in AOA training programs that do not achieve ACGME accreditation by June 30, 2020, the AOA established a policy in 2016 that requires programs to file an application by a prescribed date in order to continue to enroll residents. The prescribed filing date corresponds with the length of the training program. Programs that filed ACGME accreditation applications by the prescribed date would be allowed to accept trainees whose training would go beyond June 30, 2020. Those prescribed dates are codified in Section X of the AOA's Basic Documents for Postdoctoral Training.6 The prescribed filing date was January 1, 2017, for 4-year and longer training programs; January 1, 2018, for 3-year programs; and January 1, 2019, for 2-year and 1-year programs.

In the event that a program misses the filing deadline for that year, a pathway was developed for training programs to contract with trainees when all of the following conditions are met:

1. The contract must be reported to and approved by the chief academic officer at the Osteopathic Postdoctoral Training Institution (OPTI).

2. The chief academic officer will only approve the contract if there is documentation that the ACGME accreditation application was submitted and the program has pre-accreditation status.

3. The chief academic officer may approve a contract to be issued only after the AOA Match, NRMP Match, and NRMP Supplemental Offer and Acceptance Program have concluded for that year.

The last AOA Match is expected to be held in February 2019. With a single match, osteopathic medical students will no longer have an exclusive match for which only they will be eligible. However, the dissolution of the AOA Match will have many advantages. Students will no longer face the challenge of determining which Match to enter or, if entering both, how to complete 2 rank order lists. It will also reduce students’ time and financial expenses by not having to enter data and pay fees to 2 application services and separate Matches. They will also not be confronted with the dilemma of their first choice being in one match and their second choice being in another.

Program Size

Typically, AOA programs have smaller numbers of trainees than ACGME programs.7 Some ACGME specialty standards have a program size minimum. For those specialties, concern was raised that AOA programs would not meet the minimum program size standards. In response, the ACGME affirmed that accreditation would not be denied based on program size.

Progress Report

Applications

At the midpoint of the 5-year transition to the single accreditation system, more than 80% of AOA residency programs (712 of 862) have either achieved ACGME accreditation or submitted an application for accreditation. The 150 residency programs that have not applied may do so at any time during the transition; 33 of these programs report that they plan to apply. In a cascading effect, core residency programs must achieve accreditation before their subordinate fellowship and internship programs may apply for accreditation. Overall, more than two-thirds (853 of 1244 [69%]) of all AOA training programs (residencies, internships, and fellowships) have achieved ACGME accreditation or have submitted an application for accreditation (Figure 1). A total of 175 AOA programs were dually accredited (ie, accredited by both the AOA and the ACGME prior to July 1, 2015) at the beginning of the transition and do not need to apply again.

Figure 1.

Status of programs previously or currently accredited by the American Osteopathic Association in the single accreditation system for graduate medical education as of February 5, 2018 (N=1244).

Currently, 168 training programs are working on their applications, and an additional 51 are uncertain as to their next steps. Many of the programs currently working on their application are 1-year and 2-year programs (Table 1). As of January 1, 2018, 68 one-year programs and 12 two-year programs have achieved accreditation or have applied for accreditation. The remaining programs are eligible to apply throughout the transition period. These programs must submit an application by January 1, 2019, or receive a Program and Trainee Review Council waiver to accept trainees in 2019.

Table 1.

Programs Reporting Plans to Apply for ACGME Accreditation by Program Length as of February 5, 2018 (N=168)

Historically, the AOA averaged 44 closed programs per year for the 10 years prior to the single accreditation system. The 112 closed programs during the first 2.5 years of the transition is consistent with historical rates. The closed programs account for only 2% (186) of the filled AOA positions on July 1, 2015. More than 60% of the closed programs to date had no trainees (Table 2).

Table 2.

Reasons for AOA Program Closure, July 1, 2015, through February 5, 2018 (N=112)

Considerable growth has occurred in the number of programs achieving or applying for ACGME accreditation during 2017. The number grew from 586 programs in January 2017 to 845 programs in January 2018, an increase of 44%. Of the 259 AOA programs that applied for ACGME accreditation, 218 were 3-year programs. A first occurred in 2017, with the first AOA-integrated family medicine/neuromusculoskeletal medicine program being acknowledged as a combined program by the ACGME. A combined program, which requires approval by the applicable AOA and American Board of Medical Specialties boards, allows a trainee to complete training in 2 different specialties in a shorter amount of time than completing each specialty program sequentially.

Osteopathic Recognition

The AOA has members on all of the relevant ACGME review committees, board committees, and Board of Directors. Approximately 50 osteopathic physicians currently serve as members on those bodies. In addition, osteopathic physicians participated on the task force to review the common program requirements and on the Sponsoring Institution 2025 initiative. Several AOA certifying board members are participating in the revision of the specialty milestones.

A key element of the agreement to move forward to a single accreditation system was the preservation of osteopathic GME. Two new committees were formed within the single accreditation system: the Osteopathic Neuromusculoskeletal Medicine (ONMM) Review Committee and the Osteopathic Principles Committee (OPC). The ONMM Review Committee establishes the standards for and accredits ONMM training programs. The OPC is a recognition committee for training programs that wish to designate themselves as providing osteopathic training. Of note, only ACGME-accredited programs can receive osteopathic recognition. Programs with ACGME pre-accreditation status can submit an application for osteopathic recognition but will not be reviewed by the OPC until they have achieved ACGME accreditation.

Currently, 130 ACGME-accredited training programs have achieved osteopathic recognition. Approximately 16% of these had no previous ties to AOA accreditation (Figure 2). A 2017 AACOM survey revealed that the demand for osteopathically recognized training is strong, with 7 in 10 third-year osteopathic medical students preferring ACGME-accredited programs with osteopathic recognition over ones without such recognition.8

Figure 2.

Graduate medical education programs in the single accreditation system that have either achieved osteopathic recognition (n=130) or applied for osteopathic recognition (n=30) by accrediting body as of February 5, 2018. Abbreviations: ACGME, Accreditation Council for Graduate Medical Education; AOA, American Osteopathic Association.

Graduate medical education programs in the single accreditation system that have either achieved osteopathic recognition (n=130) or applied for osteopathic recognition (n=30) by accrediting body as of February 5, 2018. Abbreviations: ACGME, Accreditation Council for Graduate Medical Education; AOA, American Osteopathic Association.

This year, more than 300 osteopathic physicians are expected to complete osteopathically recognized training, and 24 allopathic physicians are currently training in osteopathically focused tracks.

The AOA, through its Council on Osteopathic GME Development, is promoting osteopathic recognition. The Council has compiled a list of journal articles that support reasons to apply for osteopathic recognition,9 including the following:

■ reducing cost and improving care

■ ensuring osteopathic distinctiveness

■ attracting more high quality candidates

The Council is developing a plan to proactively promote osteopathic recognition to osteopathic and allopathic groups and at professional educational conferences. These efforts may include webinars to all ACGME programs, presentations at the ACGME annual education conference, and direct telephone, email, and postcard communications from the AOA. Osteopathic specialty colleges are encouraging training programs to seek osteopathic recognition as well.

New Program Growth

Despite the AOA's focus on the transition process, new AOA programs and positions are growing. The AOA Program and Trainee Review Council approved 37 new training programs, representing 134 filled positions for the 2017-2018 training year. In addition, the AOA is aware of training programs that have applied for new training positions as they transition to ACGME accreditation. The AOA is in the process of compiling this information. Osteopathic medical schools have incentives (through the standards of the Commission on Osteopathic College Accreditation) to produce new residency training programs, which will apply for accreditation directly through the ACGME. This area requires further study.

Looking Forward

The ACGME review committees will be busy in 2018, with nearly 280 AOA programs currently assigned ACGME pre-accreditation status. In addition, the number of programs that achieved accreditation early in the transition process are entering their continued accreditation review cycle. Meanwhile, the AOA will focus on encouraging 1- and 2-year training programs to apply for ACGME accreditation, assisting programs in continued pre-accreditation, and increasing the number of ACGME programs with osteopathic recognition. The AOA's Application Assistance Program offers free consultations to training programs requesting application assistance. Programs are encouraged to contact singleGME@osteopathic.org for assistance.

Graduate medical education programs in the single accreditation system that have either achieved osteopathic recognition (n=130) or applied for osteopathic recognition (n=30) by accrediting body as of February 5, 2018. Abbreviations: ACGME, Accreditation Council for Graduate Medical Education; AOA, American Osteopathic Association.

Graduate medical education programs in the single accreditation system that have either achieved osteopathic recognition (n=130) or applied for osteopathic recognition (n=30) by accrediting body as of February 5, 2018. Abbreviations: ACGME, Accreditation Council for Graduate Medical Education; AOA, American Osteopathic Association.